Traumatic Birth Injury: Forceps & Vacuum-Assisted Deliveries

Many infants are born with minor birth injuries – even after well-managed deliveries. Labor and delivery are strenuous physical processes, during which babies find themselves subjected to mechanical forces. Their bodies are compressed in the birth canal and squeezed further by contractions. After hours of labor, a few bruises are to be expected, as is swelling. In most children, the effects of birth trauma will heal without medical treatment.

Some infants, though, sustain severe injuries during childbirth. A traumatic birth injury can have life-long complications, leaving newborns with permanent impairments. These injuries are not always avoidable. Even the most careful, experienced obstetricians are unable to prevent birth injuries during every delivery. But that’s not always the case.

Traumatic Birth Injuries Are Often Preventable

Birth injuries are relatively rare, especially in developed countries. In the United States, around 88 children will suffer injury during labor or delivery every day. Without doubt, many of these traumatic injuries occur despite the best efforts of healthcare professionals. But a shocking proportion of birth injuries involve medical negligence. Nearly one half of birth trauma injuries are at least “potentially” avoidable, according to Nirupama Laroia MD, Associate Professor of Pediatrics at the University of Rochester School of Medicine.

Writing for Medscape, Dr. Laroia observes that up to 1 in 2 traumatic birth injuries could be prevented “with recognition and anticipation of obstetric risk factors.” In short, many serious birth injuries don’t come out of the blue. With proper evaluation and careful observation, obstetricians can – in many cases – predict which infants are likely to suffer harm before that harm has occurred.

Some women are more likely to experience long, difficult deliveries, which significantly increase the risk for birth injuries. Some infants, for that matter, are larger-than-average, living at an increased risk of birth injury themselves. These risk factors can be identified prior to delivery, allowing medical professionals to develop alternative plans for childbirth. Serious risk factors often make cesarean section a reasonable, if not necessary, choice.

Risk Factors For Birth Trauma Injuries

In an influential 1984 study, doctors at Georgetown and the University of Connecticut identified the following risk factors for a traumatic birth injury:

forceps delivery

shoulder dystocia

infants greater than 7.7 pounds

second stage labor longer than 60 minutes

Nirupama Laroia adds three other risk factors to this list: vacuum deliveries, vaginal breech deliveries and “abnormal or excessive traction during delivery.” Obviously, some of these complications arise intrapartum, during the course of childbirth itself. That can make risk factors difficult, but not impossible, to identify before an infant has sustained injury.

In other cases, though, traumatic birth injuries are directly caused by obstetric intervention. During assisted deliveries, for example, physicians have a duty to use forceps and vacuum extractors with reasonable care. As Laroia notes, this duty of care is not always maintained.

Assisted Deliveries

Birth trauma is likely most common among infants delivered using birth-assistive devices: forceps and vacuum extractors. In order to be delivered safely, some children need help. Despite significant risks, many obstetricians turn to these instruments, applying clamps or vacuums to an infant’s delicate body and exerting physical force.

The dangers should be obvious. Vacuum extractors increase the risk of traumatic brain bleeds more than ten-fold, as Swedish researchers discovered in 2014. The devices also appear to make fetal complications, including jaundice, more likely. Forceps are even more harmful, especially in the hands of an inexperienced practitioner.

Brachial plexus injuries – nerve damage that normally causes weakness or paralysis in the arm – frequent in babies who experience shoulder dystocia and often caused by excessive pulling

Bell’s palsy – a facial nerve injury that can result in permanent paralysis – extremely common in forceps or vacuum extractor deliveries

Intracranial hemorrhage – bleeding in the brain is relatively common after vacuum-assisted deliveries -improperly treated, brain bleeds can lead to permanent brain damage, along with cerebral palsy, a neuromuscular disorder

Manually-assisted delivers can also result in severe harm. In cases of shoulder dystocia, a child’s head is able to exit the birth canal, but their shoulder remains stuck behind the mother’s pelvis. This is a medical emergency, one that can lead to oxygen deprivation and life-long brain damage. Obstetricians must intervene. But they must do so carefully to prevent inflicting their own injuries on the child.

Medical Negligence & Traumatic Birth Injuries

The concept of medical negligence is at the root of every viable birth malpractice lawsuit. In New York, healthcare professionals have a legal obligation to uphold the accepted standards of their profession. Likewise, patients are legally entitled to a reasonable level of medical care. We trust our doctors, and can hold them accountable for breaking that trust.

Medical negligence occurs when a medical professional violates the standard of care, causing or allowing injury to take place. This is a crucial concept to understand, but one that can become contentious in the course of a medical malpractice lawsuit.

Medical Standard Of Care

Defining a clear and specific standard of care is key. The standard of care doesn’t stay the same from one birth to another. It changes, according to the facts unique to each case, each pregnancy and each patient, both mothers and children.

We can’t expect physicians to treat every medical situation the same way, nor we would we want them to. Patients should be treated individually, especially when the well-being of an infant is in the balance. Every risk factor, and every pre-existing medical condition, must be taken into account.

Taking an in individual approach to each pregnancy and delivery is the only way to identify the best possible treatment options. But it also means that the standard of care – what we would expect of a reasonably careful and skilled medical professional – will change.

Medical Malpractice Lawsuits: Building A Viable Case

Experienced birth injury attorneys work closely with independent medical experts, reviewing medical records to determine what standard of care should have been followed during a client’s pregnancy and delivery. The next step to securing compensation is identifying negligent lapses in care, moments in which a client’s healthcare team violated the standard of care – acting or failing to act in the way that a reasonably careful, similarly-situated doctor would have.

Importantly, these negligent acts or omissions (failures to act) must be shown to have resulted in harm to the infant. Technically, the medical professional’s negligence must have been the “proximate cause” of a child’s injuries – but for the negligent act or omission, the child’s injuries would not have occurred. The final step is demonstrating that the child’s birth injuries have had an adverse financial impact on the family.

Can Our Family File A Birth Injury Lawsuit?

Before reviewing your situation in detail, there’s no way to answer that question. But we believe that every serious birth injury is cause for concern. Our experienced birth injury malpractice attorneys are here to help. Think something went wrong in the delivery room? Feel free to contact us. You can learn more about your legal options at no charge and no obligation.